Noninvasive visualization of the left main coronary artery by cross-sectional echocardiography.

Abstract

Real time cross-sectional echocardiographic studies of the left main coronary artery (LMCA) were performed in 15 normal patients, 15 patients with angiographically proven coronary artery disease but normal left main coronary segments, three patients with greater than 75% obstruction of the left main coronary artery, and one patient with a larger aneurysm of the left main coronary artery. In normal subjects the LMCA evaginates from in inferolateral wall of the aorta. The artery appears as two dominant parallel linear echoes separated by a clear space representing the lumen of the vessel. The LMCA courses beneath the right ventricular outflow tract and can generally be followed to its expected point of bifurcation. Confirmation that this structure was in fact the LMCA was obtained by injection of cardiogreen dye directly into the LMCA in two cases and by visualization of dye in this structure following aortic flush in one case. In the three cases with obstructive lesions of the LMCA, there was an area of inward bending of the parallel vessel wall echoes resulting in varying degrees of narrowing of the arterial lumen. In the case with the aneurysmal dilatation of the LMCA, an echo-free circular bulge in the distal portion of the LMCA was recorded. This study demonstrates the fesibility of recording the left main coronary artery using the cross-sectional echocardiographic technique.

Ultrasonic Features of Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery

“…Vol.19 No. 1 The other question is why the cross-sectional echocardiographic pattern of the right coronary artery does not appear as 2 parallel dominant linear echoes which have been already described as its pattern.6) The dilated right coronary artery in this study shows a semicircle-shaped appearance on the long axis, and lunar or oval shaped appearance on the short axis. As shown in Fig.11, this should be explained by oblique projection of the ultrasound beam to the bending artery, which is similar to the pipe cut in half obliquely.…”

Failure of multiple coronary angiographies to identify left main coronary artery disease in a patient diagnosed by transesophageal echocardiography

“…Weyman was the first to describe the feasibility of visualizing the LMCA with transthoracic echocardiography. 1 Other studies demonstrated the ability of detecting the distal left anterior descending coronary artery using high frequency transducer (7.5 MHz) in 85% of patients.…”

Prevalence of the Anomalous Aortic Origin of a Left Coronary Artery from the Right Coronary Sinus and Posterior Course: detection by Transthoracic Echocardiography in an Unselected Ambulatory Population

“…Transthoracic echocardiography (TTE) has been used to explore coronary anatomy [7][8][9] and found to be a valuable tool mainly for identifying coronary anomalies in pediatric patients [10]. Transesophageal echocardiography has been shown to accurately assess coronary anatomy in adults with an image quality suitable to detect and evaluate the anomalous course and/or origin of a coronary vessel [11][12].…”